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Uveitis and Ocular Infections

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What Is Uveitis?

Uveitis is a condition that occurs in the uvea, or the middle area of the eye. Because the uvea contains the blood vessels that supply nutrients to the eye, any form of uveitis may be serious and may be a symptom of other serious conditions.

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Types of Uveitis

There are three types of uveitis:

  1. Anterior uveitis is the most common form of uveitis. It affects the iris and ciliary body and may be associated with autoimmune disorders such as various types of arthritis. Iritis may develop suddenly and may last up to eight weeks, even with treatment, or may have a chronic course, requiring prolonged treatment.
  2. Intermediate uveitis is an inflammation of the middle portion of the eye, the vitreous gel, and the retina. This may develop suddenly and last several months or have a chronic, indolent course.
  3. Posterior uveitis affects the back of the eye and involves the retina, choroid, or both. It may progress quickly, making it difficult to treat. Retinitis may be caused by viruses, such as shingles or herpes simplex virus, and bacterial infections, such as syphilis or toxoplasmosis. Choroiditis is an inflammation of the layer beneath the retina. It may also be caused by an infection, such as tuberculosis. Retinitis and choroiditis can also be caused by an autoimmune disease. However, in a large number of cases, the cause of uveitis is not known.

Symptoms

Symptoms of uveitis may include the following:

  • Eye redness and irritation.
  • Blurred vision.
  • Eye pain or soreness.
  • Increased sensitivity to light.
  • Floating spots before the eyes.
  • Flashing lights.

Complications

Complications of uveitis may include glaucoma, cataracts, abnormal growth of blood vessels in the eyes that interfere with vision, fluid within the retina (edema), retinal detachment, membrane formation anywhere in the eye, low pressure, all of which may result in vision loss.

Causes

Uveitis has many potential causes, including the following:

  • Infection with a virus, fungus, bacteria or parasite
  • Inflammatory disease affecting the eye only or as a coming of a systematic disease involving other parts of the body
  • Injury to the eye
  • Malignancy (rare)

Uveitis may also have an underlying cause elsewhere in your body, and your ophthalmologist may want to talk with your primary care doctor or another medical specialist to evaluate your overall medical health.

Diagnosing Uveitis

After performing a careful medical and ocular history, review of systems, and an examination of your eyes, your doctor may also order laboratory tests, including blood work or X-rays, to confirm the diagnosis or exclude important infections or neoplastic processes. Sometimes, surgery to obtain an intraocular biopsy or sample of ocular fluid is necessary to establish the diagnosis.

Treatment

Because uveitis is potentially vision-threatening, treatment needs to begin right away if inflammation is active.

  • Steroids are the first line of treatment for uveitis not caused by an infection. Steroids may be administered topically (drops), injected around or into the eye, or delivered systematically (pills) depending on the severity and location of the inflammation.
  • Non-steroidal anti-inflammatory drugs, or immunomodulating agents, are administered as first-line therapy for certain diseases that are vision or life-threatening, and as a part of a steroid-sparing strategy for patients who do not respond or tolerate systematic steroids, develop unacceptable side effects, or in whom extended inflammatory therapy is anticipated.
  • Antibiotics are used in patients with infectious uveitis.
  • Dark glasses and cycloplegic drops (dilating) will help with light sensitivity.